Day 1 :
Keck medical school USC(University of Southern California), USA
Keynote: Trauma Team Dynamics
Time : 10:00-10:40 AM
Dimitrios Karakitsos is an Associate Professor in Medicine at University of South Carolina, School of Medicine and an Adjunct Associate Professor in Critical Care at Keck Medical School, University of Southern California. He is an international, well-published expert and Researcher in “Critical care ultrasound and crisis resource management in trauma”. Currently, he is also affiliated to the Trauma Center of King Saud Medical City (KSMC) in the Kingdom of Saudi Arabia.
Background: In trauma care, teams of experts are using modern technology and techniques to secure life and limb, conserve organs in acute peril and manage chronic complications. Trauma care also requires the coordination of individuals with different biases, priorities, personalities, skill sets and timelines. Although the American College of Surgeons’ Advanced Trauma Life Support (ATLS) course has been the backbone of trauma care, it focuses on the sole practitioner, rather than how we function in larger teams and complex situations.
Methods: In 1977, a large aviation disaster has led NASA to the development of crew resource management training. These ideas have been adapted to medicine and resulted in crisis resource management (CRM) training. Human errors in medicine are estimated to contribute to approximately 100,000 annual deaths in the United States alone. Simulation trauma team training typically encompasses five keys areas: communication, leadership and followership, resource utilization, problem solving and situational awareness. While even routine civilian trauma can be challenging, add to this the potential for natural disasters, terrorist attacks, and other such fluid environments and CRM training becomes imperative. Finally, CRM logistics have led to the development of temporary constructs such as Emerging Multi-Organizational Networks (EMON) which consist of task-oriented and mission specific collaborations of individuals and resources.
Conclusions: The addition of CRM skills to modern trauma care is of growing interest. Whether the former may improve team performance, team empathy and patient outcomes is an area of on-going research.
Laval University in Quebec City, Canada
Time : 11:00-11:40 AM
Lynne Moore is an Associate Professor of Epidemiology and Biostatistics in Department of Social and Preventative Medicine at Laval University in Québec City. She is recipient of a Research Career award and has published 140 peer-reviewed papers over her research career. Her research interests include “Improving the quality of acute injury care”. She has led the development, validation, implementation and evaluation of a comprehensive quality tool assessment for acute injury care which has been implemented across Canada. She is Co-leader of International Injury Care Improvement Initiative.
Statement of the Problem: In response to evidence of variation in patient outcomes across providers and growing financial pressures, healthcare authorities in high-income countries have emphasized the urgent need to develop tools to monitor quality of care.
Aim: Aim of this study is to develop Canadian benchmarks to monitor mortality and hospital length of stay (LOS) for injury admissions.
Method: Benchmarks were derived from data from the Canadian National Trauma Registry on patients with major trauma admitted to any level I or II trauma center in Canada and the following patient subgroups: isolated traumatic brain injury (TBI), isolated thoracoabdominal injury, multisystem blunt injury, aged ≥65 years. Predictive validity was assessed using measures of discrimination and calibration. Extensive sensitivity analyses were performed to assess the impact of replacing analytically complex methods (multiple imputation, shrinkage estimates and flexible modelling) with simple models that can be implemented locally.
Results: The mortality risk adjustment model had excellent discrimination and calibration (area under the receiver operating characteristic curve=0.883; Hosmer-Lemeshow=122). The LOS risk-adjustment model predicted 31% of the variation in LOS. Overall, observed-to-expected ratios of mortality and mean LOS generated by an analytically simple model were highly correlated to those generated by analytically complex models (r>0.95; kappa on outliers>0.90).
Conclusion & Significance: We propose Canadian benchmarks that can be used to monitor quality of care in Canadian trauma centers using a simple Excel program (provided) that can be implemented using local trauma registries. We observed significant variation in mortality and LOS across Canadian trauma centers indicating room for improvement in the quality of acute care for Canadian injury admissions.
University of Medicine and Pharmacy at HCM city, Vietnam
Keynote: Direct Traumatic Carotid Cavernous Fistula: Angiographic Classification and Treatment Strategies. Study of 172 Cases
Time : 11:40-12:20
Cuong Tran Chi is a Medical Director of Stroke International Services System, Vietnam. He is the President of Interventional Neuroradiology Society of HCM city, Vietnam and Senior Consultant of Interventional Neuroradiology of Vietnam. He has been a member of World Federation of Interventional and Therapeutic Neuroradiology (WFITN) since 2007. He has performed more than 2000 Neuro-interventional procedures including: Carotid cavernous fistula, intracranial and spinal dural fistula, and treatment aneurysm by coiling, treatment AVM, carotid stenting and intracranial stenting, flow-diverter stenting, percutaneous vertebroplasty.
Objectives: We report our experience in treatment of traumatic direct carotid cavernous fistula (CCF) via endovascular intervention. We hereof recommend an additional classification system for type A CCF and suggest respective treatment strategies.
Methodology: Only type A CCF patients (Barrow’s classification) would be recruited for the study. Based on the angiographic characteristics of the CCF, we classified type A CCF into three subtypes including small size, medium size and large size fistula depending on whether there was presence of the anterior carotid artery (ACA) and/or middle carotid artery (MCA). Angiograms with opacification of both ACA and MCA were categorized as small size fistula. Angiograms with opacification of either ACA or MCA were categorized as medium size fistula and those without opacification of neither ACA nor MCA were classified as large size fistula. After the confirm angiogram, endovascular embolization would be performed impromptu using detachable balloon, coils or both. All cases were followed up for complication and effect after the embolization.
Results: A total of 172 direct traumatic CCF patients were enrolled. The small size fistula was accountant for 12.8% (22 cases), medium size 35.5% (61 cases) and large size fistula accountant for 51.7% (89 cases). The successful rate of fistula occlusion under endovascular embolization was 94% with preservation of the carotid artery in 70%. For the treatment of each subtype, a total of 21/22 cases of the small size fistulas were successfully treated using coils alone. The other single case of small fistula was defaulted. Most of the medium and large size fistulas were cured using detachable balloons. When the fistula sealing could not be obtained using detachable balloon, coils were added to affirm the embolization of the cavernous sinus via venous access. There were about 2.9% of patient experienced direct carotid artery puncture and 0.6% puncture after carotid artery cut-down exposure. About 30% of cases experienced sacrifice of the parent vessels and it was associated with sizes of the fistula. Total severe complication was about 2.4% which included one death (0.6%) due to vagal shock; one transient hemiparesis post-sacrifice occlusion of the carotid artery but the patient had recovered after three months; one acute thrombus embolism and the patient was completely saved with recombinant tissue plasminogen activator (rTPA); one balloon dislodgement then got stuck at the anterior communicating artery but the patient was asymptomatic.
Conclusion: Endovascular intervention as the treatment of direct traumatic CCF had high cure rate and low complication with its ability to preserve the carotid artery. It also can supply flexible accesses to the fistulous site with various alternative embolic materials. The new classification of type A CCF based on angiographic features was helpful for planning for the embolization. Coil should be considered as the first embolic material for small size fistula meanwhile detachable balloons was suggested as the first-choice embolic agent for the medium and large size fistula.
Hamad Medical Corporation, Qatar
Keynote: Sequential trauma education programs (STEPS):The experience of advanced trauma care education in low and middle income countries
Time : 12:20-13:00
Mohamed E Abbasy is currently working as an Emergency Medicine Clinical Fellow at Hamad Medical Corporation, Qatar. He successfully completed his Injury Prevention Research and Training Program at University of Maryland, School of Medicine, Maryland, USA. He has attended R Adams Shock Trauma Center, University of Maryland, School of Medicine, Maryland in 2008. He completed his training in Emergency Medicine and successfully awarded the fellowship of Egyptian Board of Emergency Medicine in 2009. He has a good experience of working in Gulf region and worked as an Assistant Program Director of Saudi Board of Emergency Medicine in Eastern region, KSA in 2013. He successfully passed his membership examination of Royal College of Emergency Medicine UK in 2014 and European Board of Emergency Medicine in 2016. His research interest includes Critical Care, Trauma and Emergency Ultrasound.